Individual provider Active NPI

Sanjay D Patel, M.D.

  • Family Medicine Physician
  • Wake Forest, NC
National Provider Identifier
1376560938
Registry record updated May 19, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2011-01665 Issued in NC
Practice address
11635 Northpark Dr
Wake Forest, NC 27587-6526
Phone
(919) 570-6060
Fax
(919) 570-0404
NPI assigned
Jul 17, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 19, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 9143 NH
Family Medicine Physician 207Q00000X 2011-01665 NC Primary

Addresses

Primary practice location

11635 Northpark Dr
Wake Forest, NC 27587-6526

Mailing address

5213 S Alston Ave
Durham, NC 27713-4430
Phone (919) 620-4917

Other identifiers 1

IdentifierTypeStateIssuer
30006798MedicaidNH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111025000772 NC Practitioner - Family Practice 7214955582 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
2011-01665NCMDFamily Medicine Physician
9143NHMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Duke University Affiliated Physicians, Inc. Family Medicine CurrentSince Sep 28, 2011 Accepting new patients
Duke University Affiliated Physicians, Inc. Family Medicine Current Accepting new patients
Duke University Affiliated Physicians, Inc. Family Medicine CurrentSince Sep 28, 2011 Accepting new patients
Duke University Affiliated Physicians, Inc. Family Medicine Current Accepting new patients

Locations

5213 S Alston Ave
Durham, NC 27713
Phone (919) 620-4700

1901 Hillandale Rd
Ste D
Durham, NC 27705
Phone (919) 383-4355

480 Ruin Creek Rd
Henderson, NC 27536
Phone (252) 492-3152

13300 Strickland Rd
Raleigh, NC 27613
Phone (919) 385-6800

7200 Creedmoor Rd
Ste 208
Raleigh, NC 27613
Phone (919) 327-1650

2406 Blue Ridge Rd
Ste 250
Raleigh, NC 27607
Phone (919) 787-2542

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1337385600000",
    "number": "1376560938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5213 S ALSTON AVE",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277134430",
            "telephone_number": "919-620-4917",
            "fax_number": "919-620-4921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11635 NORTHPARK DR",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275876526",
            "telephone_number": "919-570-6060",
            "fax_number": "919-570-0404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATEL",
        "first_name": "SANJAY",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2012-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NH",
            "license": "9143",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "2011-01665",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30006798",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wake Forest, NC

Sources for this page

Verify at the official NPI Registry.